You're not the first to get an STI

If you ever thought that you were the first or only person to have had a sexually transmitted infection (STI) – think again; they have been around for thousands of years. Gonorrhoea was first mentioned in the Bible and the name of the disease was given by the second-century Greek physician Galen. The origin of syphilis is less clear but by the 16th Century it was making its way across Europe.

Anybody can get a STI from someone who already has one. The trouble is that STIs are usually passed on by someone who doesn’t know that they have an infection and so just asking your partner won’t protect you. The majority of STIs enter the body through tiny abrasions, sores or cuts in the body, many of which can be invisible to the eye. A few STIs only itch, some are painful, some are permanent and many can be serious if left untreated.

Effective prevention, protection and treatment will significantly reduce the likelihood of getting STIs or, if you do get them, will reduce or eliminate the harm they can cause.

Over recent decades, HIV has affected the lives of gay men everywhere and has changed the way we think about sexual health. Not only do we have a better understanding of our health needs, but many sexual health services have responded to the need for improvement. None of us really want to dwell on STIs, but being aware on what’s going on leaves you free to concentrate on having a good time.

Reducing risks

Be proactive

Being sexually healthy is not only about dealing with sexual problems as they arise, it’s also about avoiding problems in the first place. Most sexual activity carries some kind of risk of getting an STI and, while never pleasant, many gay men see them as an occupational hazard.

You significantly reduce the risk of getting or passing on STIs by:

Prompt visit to a sexual health clinic if you think you have a STI

Vaccination against hepatitis A and B

Routine clinic check-ups every 3-6 months. If you have unprotected sex, use drugs or have had a recent STI, we suggest you have check ups every 3 months

Symptoms

STI symptom sorter

Match your symptoms with our symptom sorter below and you should get an indication which STI you may have. The sorter is for guidance only and to satisfy curiosity. If you’re checking out your own symptoms then that’s reason enough (in our book) to get a clinic check-up now, where tests can determine whether you have a STI or not. Some symptoms can also indicate other illnesses or medical problems. All the more reason to see someone as soon as possible.

STI self-test kits

STI self-test kits

Sexual Health London (SHL) is London’s sexual health e-service that provides free sexual health testing via the internet and local venues. Simply register for SHL and complete an online consultation to order your free STI test kit. Please note the service is designed for individuals who have no symptoms. If you have symptoms please attend your local sexual health clinic.

The service is available to people aged 16 and over who are residents in most Boroughs of London. The following boroughs have chosen not to participate in SHL:

Hillingdon

Hounslow

Sutton

Croydon

Greenwich

The service provides testing for a range of sexually transmitted infections including chlamydia, gonorrhoea, HIV, syphilis, hepatitis B and hepatitis C via samples you can collect at home.

STI statistics

Statistics and trends

Several recentstudies have linked PrEP with a modest rise in STIs. Traeger’s team analyzed eight studies with 4,400 participants and found that starting Truvada for prevention was associated with a 24% increase in such diagnoses. The US study presented in Amsterdam only found one statistically significant STI-related shift in the cohort: after men stopped PrEP, the diagnosis rate for rectal chlamydia or gonorrhea infections fell by 80%.

Antibiotics

Antibiotics

Antibiotics (also known as antibacterials) are used to treat or prevent bacterial infections. They work by either killing the bacteria or preventing them from reproducing and spreading. The development of antibiotics has been long and complicated. It wasn’t until the 1940s they were first used; their successful use has been one of the greatest advances in medicine.

However, now due to the overuse of antibiotics, there are some bacteria that are resistant (i.e. they don’t respond) to the antibiotics that worked in the past. It is important that you always use all the antibiotics you are given, even if you feel better as then the treatment is more likely to be successful. It also reduces the chances of the bacteria becoming resistant in the future.

Antibiotics are used to treat chlamydia, gonorrhoea and syphilis, however some strains are now resistant to the antibiotics normally used to treat them, this means it will be more difficult to treat you if you get one of these strains.

Until recently the main way to avoid getting sexually stransmitted infections (STIs) and HIV was to either not to heve sex or to use condoms during sex. However, there are now concerns the sustained and widespread use of PrEP will see a reduction in condom use, resulting in an increase in STIs (other than HIV) at a time when the antibiotics used to treat some STIs no longer work.

HIV treatment

HIV is treated with a combination of drugs called ‘antiretrovirals’, also known as antiretroviral therapy (ART). These drugs work to stop the virus from making copies of itself (multiplying) and so reducing the amount of HIV in the body. Reducing the HIV in your body enables your immune system to recover, giving it a greater chance of fighting off, and recovering from, infections and other illnesses.

Whether you have been recently diagnosed yourself, or if you know somebody living with HIV, understanding even a little bit about CD4 counts and viral loads is worth knowing. For example, you might hear someone say “I’m undetectable and my CD4 count is 781” but what does it mean?

A CD4 count is a blood test that measures CD4 T lymphocytes (CD4 cells) in 1 cubic millimetre of blood. It shows the ‘strength’ of your immune system function to fight off infections. Normal CD4 counts range from 500 to 1,500 cells. A CD4 count of less than 200 is one of the ways to determine if a person with HIV has progressed to AIDS. This doesn’t mean a person is near death, but rather that their immune system is so badly damaged that they would have great difficulty fighting off an infection if one were to come along.

A viral load blood test measures the number of active HIV virus copies (or particles) there are in 1 millilitre of blood. For example, a person not on HIV treatment may have a viral load of several million. A higher viral load means a person will be more infectious to others; eg: through unprotected fucking. The goal of HIV treatment is to bring your viral load down to undetectable levels which is usually regarded as less than 100.

We are oversimplifying but as crude example: A person with HIV infection and not on HIV medication might have (when tested) a viral load of 1,000,000+ and a CD4 of 370. Once on HIV treatment (eg: 3-6 months later) that person would be looking good if the viral load was less than 100, and the CD4 count was 500.

Effective HIV treatment is about keeping your CD4 count high and your viral load low or undetectable. We should also add that CD4 counts and viral loads can go up and down depending on how well your HIV medication is working, whether you’ve another STI, and your health generally. This is not unusual.

The clinic doctors specialising in HIV are very experienced in both telling you what you need to know, and answering your questions and concerns.

Today’s HIV treatments are extremely effective, enabling in the majority of cases a normal life expectancy; particularly if you are diagnosed early (the point of infection). Being on ART also reduces the risk of transmitting HIV to others.

You will need to take your HIV tablets as prescribed, which in most cases is one daily dose, to ensure you have enough medication in your body to keep the HIV in check. So, no messing around and missing doses!

Some people do experience side-effects, which can vary between treatments and individuals, although after a few weeks most usually subside or if they don’t can be alleviated by medication. There is still no cure but for most people HIV is now a ‘chronic condition’, a serious but manageable illness that you will live with for the rest of your life.

NAM works to change lives by sharing information about HIV and AIDS. It produces useful information that you can trust, and makes sure it is there for anyone who needs it. It believes that having independent, clear and accurate information is vital in the fight against HIV and AIDS. It enables individuals and communities affected by HIV to protect themselves, care for others, advocate for better services and challenge stigma and discrimination.

Formed in 2000, HIV i-Base is a treatment activist group providing timely and up to date information about HIV treatment to HIV positive people and to health care professionals. All resources are produced by and with the involvement of HIV positive people and are reviewed by a medical advisory group.

Set up in 2002, The UK-CAB is a network for community HIV treatment advocates across the UK. Among its aims: to develop and strengthen a network of treatment advocates, provide expert training on current treatment issues and develop community representation in clinical trials, and setting the standard of care open to HIV positive people and community advocates.

After a HIV positive diagnosis

Everyone’s experience of being diagnosed with HIV is different. As the news sinks in and you start to come terms with what it means, you may go through a range of different feelings. You may feel like being by yourself, or being with just your partner, you may want to chat with a close friend, or you may want to speak to a professional counsellor, perhaps at the clinic where you received your diagnosis.

Once you’ve been told your diagnosis you may want to chat with other people who have are HIV positive. A number of organisations run groups where you can share your experiences with other newly diagnosed people, including groups that are just for gay men. You may not necessarily all be going through the same feelings and emotions, or want to ask the same questions, but these groups can be a usefully way to find support and share experiences.

First steps at the clinic

After your HIV diagnosis, several things are likely to happen:

You will be subjected to a flurry of medical tests to establish your state of health and to what extent the virus is affecting your immune system.

If appropriate, you may be offered treatments to reduce or stabilise the level of HIV in your body or treatments to help prevent the development of opportunistic infections.

Depending on your needs, state of health and circumstances, you will be helped to apply for benefits or put in touch with a social worker or home care support team.

There is sometimes an assumption by professionals that because you are gay you know what to do and where to go. This is, of course, not likely to be true where your new HIV diagnosis is concerned. Of course it may be difficult to gauge whether you’re getting the information you need and want, but if you have any doubts ask – or get a second opinion from a helpline or other organisation.

This can be overwhelming, particularly at a time when there is likely to be a lot on your mind and you may be feeling very stressed and emotional. Spare some thought for how you are feeling. Being HIV positive can play havoc with your emotions. Whether you chat regularly with a mate, attend a group, phone a helpline or seek professional help – don’t ignore your feelings. Some find it difficult to ask for help or accept it, but there’s nothing wrong with getting it or asking for it.

We all need help once in a while – it doesn’t mean that we are weak or incapable. Equally, saying ‘no’ doesn’t necessarily mean you are being awkward – so don’t feel guilty or afraid about saying it. The following tips are designed to make getting help and support easier, and so you make decisions which suit you and meet your needs.

Try to deal with one thing at a time.

Find a doctor or clinic you like. If you don’t like them, change them.

Make decisions in your own time.

Take at least some time to learn more about HIV and how it could affect you. But you don’t have to become an expert or know everything at once. Knowing more will help you feel more in control.

Consider how you could make your lifestyle healthier. It may include, for example, changes to your diet, having more fun or doing relaxation exercises. Even if you think you’re a sceptic, give it a chance; you can always go back to clubs, drugs, and ready-made-meals – they ain’t going nowhere!

Listen to your body, it’s usually pretty good at telling you what it likes and doesn’t like. You may take it for granted but it is your friend, get to know and understand it better.

If there are changes to be made to your life, they are rarely drastic or wholesale and you don’t have to make them all at once. You have time.

If you’re attending an appointment, there’s nothing to stop you taking someone with you. A little moral support and another pair of ears can be very helpful.

When you are speaking about your HIV, particularly in relation to HIV services, you may come across people whom you don’t know, don’t like or who don’t seem to understand what your needs are. Here are some tips to get you through:

Be honest and direct – say what’s on your mind.

Consider taking notes and preparing some questions beforehand. This way you can take the information away and understand it better in your own time.

Listen to what is being said and think what you want to say next before opening your gob.

If you’re getting irritable or angry, say so… then take some deep breaths, take a break, or go to the toilet. If you really can’t handle it, leave. You can always go back when you’re ready.

If you’re told something which you don’t understand, repeat what’s been said in your own words and ask if you’ve understood correctly.

“Al is 26 from Dublin, Ireland and also struggled massively when he was diagnosed a few years ago. “The only shit thing about having HIV is the shock, depression, and anxiety that follows the diagnosis. I felt total panic, thought I couldn’t ever have sex again, that nobody would ever be in a relationship with me. I was severely depressed. I felt lost, lost, lost, for about a year. Doctors were telling me everything would be fine but nothing went into my head,” he recalls. “It all stems from stigma and misunderstanding around HIV”.

The lingering cultural and psychological aversion to HIV belies the incredibly optimistic medical realities. Antiretroviral medication is now so sophisticated that most HIV+ people take one pill a day, which suppresses the virus in the body. This means that HIV+ people on medication have a normal lifespan, live healthily, and can have unprotected sex with their partners without ever transmitting the virus (this is where the slogan U=U, undetectable = untransmittable, comes from).

“I’ve had HIV for six years now and I haven’t sneezed”, jokes Al. “I’m taking the most advanced medication which kills all the HIV in my blood except the dormant cells. I’ve been with my boyfriend (he’s negative) for two years and we don’t have to use condoms because I cant pass the virus on. It’s impossible. Everything is fine”.”

Telling others your HIV status

People have different reasons for disclosing their HIV status. For some, it may be to get support or health care whilst others might want their sexual partner(s) to know. You might have met somebody and it’s getting serious, you’re in a relationship or you’re in an open relationship. Or, you might be having sex and ‘something’ comes up … questions are asked … or maybe you just feel you need to say something. It could be none of these and something else.

Whatever reaction you get telling others about your HIV status, being HIV positive is nothing to be ashamed of. Hopefully, those you do tell will respond positively but that’s not the whole picture: some people will respond negatively and reject you. This often changes with time, particularly if they are up to date with advances in treatment and undetectable = transmissible for example … and finding out the facts, rather than clinging onto misconceptions, ignorance, and stigmas about HIV.

For some HIV positive gay men, disclosing (telling others) their status can be as stressful or as traumatic as coming out as gay. It is important to think carefully about who you want to tell and why. Once you have told someone about being HIV positive, you cannot take the information back. Coming out is a very personal process and should be your choice.

Obviously, it can feel very natural to want to tell a partner and/ or family immediately but the response may not be what you expect. It certainly doesn’t help to be dealing with other people’s crap while still sorting out your own. If, however, you have decided to come out, the following may be helpful:

Be aware that telling people may affect you more than you think and they may not react in the way you expect

People are human: don’t tell people if you don’t want them to tell others

Try and prepare yourself for the questions they may ask or the issues they may bring up

Try and choose the right time and place

Not telling someone about your diagnosis might prevent you getting the medication, support, advice and services you need

Undetectable = Untransmittable

U=U means Undetectable = Untransmittable which means if someone with HIV has an undetectable viral load then they cannot pass on the virus through sex. The PARTNER Study says:

“Our results provide a similar level of evidence on viral suppression and HIV transmission risk for gay men to that previously generated for heterosexual couples and suggest that the risk of HIV transmission in gay couples through condomless sex when HIV viral load is suppressed is effectively zero. Our findings support the message of the U=U (undetectable equals untransmittable) campaign, and the benefits of early testing and treatment for HIV.”

HIV organisations across the world have joined the U=U campaign to endorse the statement that HIV sexual transmission does not occur when viral load is undetectable on HIV medication or antiretroviral therapy (ART). While the impact of HIV medication on reducing HIV transmission has been known for a long time, it’s new to say ART stops sexual transmission completely. This change is especially important given that prejudice and discrimination against HIV positive people is still widespread.

“An end to the AIDS epidemic could be in sight after a landmark study found men whose HIV infection was fully suppressed by antiretroviral drugs had no chance of infecting their partner. The success of the medicine means that if everyone with HIV were fully treated, there would be no further infections.”End to AIDS in sight as huge study finds drugs stop HIV transmission | The Guardian | 2 May | 2019

“A study of nearly 1,000 gay male couples in The Lancet found no cases of HIV transmission over eight years. This was due to treatment reducing the virus to very low levels in the body. “Undetectable equals untransmittable” should be basic HIV knowledge for everyone, experts said.”Gay HIV transmission with treatment is ‘zero risk’, study confirms | BBC | 3 May 2019

HIV is: just a part of me (campaign)

HIV is: Just a part of me is about supporting everyone living with HIV to feel positive about living a long and healthy life. Whether you are younger or older, newly diagnosed or been living with HIV for many years, there is HIV information available to help you stay actively involved in your health. Ensuring HIV is just a part of you. Through a series of videos, 11 men describe the events, people and experiences that have shaped the way they live with HIV.

The campaign also provides information to support HIV positive men to understand the link between HIV disease progression and long-term health management. Sections include your body, your expectations, what to ask, men’s health and real life.

Our usual disclaimer: we (at MEN R US) would add that we do not know Gilead, we have not slept with Gilead, we have no shares in Gilead, and we have not received any gifts or inducements to include this content on our website. Nuff said we think.

Living older with HIV

CIHRRC

The Canadian-International HIV and Rehabilitation Research Collaborative (CIHRRC) is an international research collaborative addressing research priorities in HIV and rehabilitation for people living with HIV in Canada, the UK and elsewhere. The areas of research are:

Episodic health and disability

Ageing with HIV across the lifespan

Concurrent health conditions

Access to rehabilitation and models of rehabilitation service provision

Effectiveness of rehabilitation interventions

Enhancing outcome measurement in HIV and rehabilitation research

The Collaborative is comprised of 40+ researchers, clinicians, people living with HIV, and representatives from community organisations in Canada and around the world.

What is episodic disability and rehabilitation?

As people live longer with HIV they may experience the health-related challenges of HIV, concurrent health conditions, and ageing. These health-related challenges may be termed ‘disability’, and may sometimes fluctuate resulting in ‘good days’ and ‘bad days’ living with HIV. The term ‘episodic disability’ is used to describe physical, cognitive, mental and emotional symptoms and impairments, difficulties carrying out day-to-day activities, challenges to social inclusion, and uncertainty or worrying about the future. It may sometimes fluctuate on a daily basis or over the longer term living with HIV. ‘Rehabilitation’ is defined as “any services or activities that address or prevent impairments, activity limitations, and social participation restrictions for people living with HIV.”

Pozcast podcast

A show that puts the positive effect in podcasting created by and for people living with HIV to understand HIV research in ways that matter. Pozcast tells stories about what HIV research means for our health, our personal lives, and our work. Pozcast is based in Toronto but global in outlook, and we’re produced by Universities Without Walls.

Episodes include:

Undetectable = Untransmittable (U=U)
A person living with HIV who has an undetectable viral load does not transmit the virus to their partners. To discuss this significant advance in science and its impact James Watson talks to two people passionate about the topic and the messaging.

Stigma Stings
HIV stigma can be more harmful than the disease itself. Is it possible to eradicate this social menace or is it here to stay? Tune in to find out as host James Watson chats with his guests about the impact of HIV stigma and how community-based research is making strides to weaken its grip.

Youth Stop AIDS

Youth-led movement campaigning for a world without AIDS (previously called Student Stop AIDS Campaign). It’s a network of young people across the UK speak out, take creative action and engage those in power to ensure that governments, global institutions and corporations are committed to ending AIDS by 2030.

HIV TESTING

HIV testing

Getting tested for HIV is quick, easy and confidential and there are more options to get tested than ever before including testing at home, at your GP or at a clinic.

There are 4 main types of HIV test:

Point of care test – a saliva sample or a small spot of blood from your finger is taken in a (sexual health) clinic. This sample doesn’t need to be sent to a laboratory and the result is available within a few minutes.

Blood test – a blood sample is taken in a (sexual health) clinic and sent for testing in a laboratory. Results are usually available on the same day or within a few days.

Home sampling kit –a saliva sample or small spot of blood at home and send it off in the post for testing. You’ll be contacted by phone or text with your result in a few days. Visit test.hiv to check if you’re eligible for a free test. If not, you can buy them online or from some pharmacies.

Home testing kit – a saliva sample or small spot of blood yourself and test it at home. The result is available within minutes. It’s important to check that any test you buy has a CE quality assurance mark and is licensed for sale in the UK, as HIV self-tests available from overseas can be poor quality

Window period

If the test finds no sign of infection, your result is “negative”. If signs of infection are found, the result is “positive”. The blood test is the most accurate test and can normally give reliable results from 1 month after infection. The other tests tend to be less accurate and may not give a reliable result for a longer period after exposure to the infection. This is known as the window period. For all these tests, a blood test should be carried out to confirm the result if the first test is positive. If this test is also positive, you’ll be referred to a specialist HIV clinic for some more tests and a discussion about your treatment options.

A positive test result

One of the drawbacks of self/ home testing kits is that you may be alone if the test comes back positive. While some people may take this in their stride, others may feel understandably stressed and worried. You may wish to think about where and when you do the test so that you can find support you need quickly, should you need it. Everyone’s experience of being diagnosed with HIV is different. As the news sinks in and you start to come terms with what it means, you may go through a range of different feelings. You may feel like being by yourself, or being with just your partner, you may want to chat with a close friend, or you may want to speak to a professional counsellor, perhaps at the clinic where you received your diagnosis. You can find our more here.

Free test kits

HIV Testing | Test HIVFree self-sampling HIV test kits are available in many areas of the country. Enter your details to check your eligibility.HIV Testing | Do It London
Fast Test | Terrence Higgins TrustWill send you a test free of charge, in an unmarked package, to any UK address. The test involves taking a small blood sample from a finger prick.

DO IT LONDON

Do It London

Do It London is an on-going campaign delivered and coordinated by the London HIV Prevention Programme (LHPP) is a London-wide sexual health promotion initiative. It aims to increase HIV testing and promote prevention choices to Londoners. The programme is funded by 31 London boroughs and managed on their behalf by Lambeth Council. As well as our city-wide Do It London campaigns, the LHPP also provides a free condom distribution, outreach and rapid HIV testing service for men who have sex with men (MSM). This service is delivered by GMI Partnership and Freedoms. It also commissions online sexual health outreach and advice via websites and apps.

PREP

PrEP (pre-exposure prophylaxis)

PrEP means Pre-Exposure Prophylaxis, and it’s the use of anti-HIV medication – taken regularly – to keep HIV negative people from becoming infected. It is not freely available throughout the NHS (as yet), though you can buy it online or get it on private prescription. While the PrEP Impact Trial has increased free access, many say it should be freely available now.

In February 2015, the PROUD study reported that PrEP reduced the risk of HIV infection by 86% for gay men and other men who have sex with men. It measured the effectiveness of daily PrEP for those recruited during the 2-year study. In the UK there is still some concern that widespread use of PrEP could reduce the number of people who are using condoms and therefore increase the number of exposures with people who are not aware of their HIV infection, and who are potentially very infectious.

NHS England have announced funding to double the size of its PrEP trial, aiming to widen participation by an additional 13,000 patients. The trial expansion will still require approval from a Trial Oversight Board, due to meet later this month. More from the National AIDS Trust here.

First anniversary of the IMPACT Trial | October 13 2018

October 13 is the first anniversary of the IMPACT Trial – a year down the line and, as we know, many clinics are full and, in spite of an additional 3,000 places, the allocation for gay men and men who have sex with men (MSM) is likely to reach capacity in the spring, well before the trial is due to end. We know that NHS England can now prescribe generic PrEP if there was to be a roll-out of routine commissioning and we know that some people who have been turned away from the trial have acquired HIV very preventably.

PrEP high court ruling | 18 September 2018

The High Court has has overturned Gilead’s patent extension on Truvada, the HIV drug also used in PrEP.

Deborah Gold, chief executive of NAT (National AIDS Trust) said: “We welcome this court decision, which overturns the patent extension for Truvada (this is the HIV prevention drug used for PrEP). The decision will mean that unbranded versions of the drug can be legally prescribed. This represents a huge cost saving to buying a drug that would save public money, even at full price. We continue to urge the NHS in England to commission PrEP by April 2019, as the current trial is not reaching everyone at risk, indeed some have acquired HIV after being turned away from clinics whose trial places are full.

“With the generic, unbranded version of the drug available at a fraction of the cost, the pressure increases on NHS England to begin routine commissioning, and make PrEP available to all who need it, urgently.”

NHS England have announce funding to double the size of its PrEP trial (Jan 2019)

PrEP Impact Trial

Some clinics in England have agreed to participate in the trial (see link below) which will be updated as sites begin opening to recruitment across the country. Clinics participating in the trial will open to recruitment in a phased approach over a few months. It is not possible to open all sites at the same time and that means that some clinics will open a few months before others. If your local clinic opens slightly later, you will still have the opportunity to join the trial. Different clinics will be ready to start at different times and the rate at which trial sites will open will be dependent on the speed at which clinics can get local approval and put systems in place to train staff and capture trial data.

“Gay and bisexual men have differing attitudes towards men who are using pre-exposure prophylaxis (PrEP), according to US research published in Sociology of Health & Illness. A series of focus groups conducted in New York City showed that some men regarded PrEP users as immoral, irresponsible, naïve and vectors of disease. In contrast, other men saw PrEP as a beneficial new option for preventing the spread of HIV. They had a nuanced view about the effectiveness of condom-based prevention campaigns and the epidemiology of sexually transmitted infections (STIs) among gay and bisexual men.”

So, what is the problem with PrEP? Why is there stigma around a pill that, ultimately, prevents HIV infection and can save lives?

“Ultimately, we are a community living in the shadow of a devastating and traumatic chapter in our history (AIDS). With PrEP and undetectable, we are asking people to unlearn everything they ever learned in a climate of fear, infection and death. We are asking people to learn the new science and the new facts, and oftentimes, change or something new can stir deep emotions and reactions. It requires us all to use the basic components of constructive debate, which are respect, compassion and kindness. It will require us to listen and be open to learn. It will be uncomfortable but it needs to happen.”

Do-it-yourself HIV prevention: who do men buying PrEP online get support from?

“Gay men in London who source their own supply of generic pre-exposure prophylaxis (PrEP) drugs, usually from overseas internet pharmacies, most often learnt about this possibility from people in their social network and would like more support from other PrEP users to be available. Nonetheless, clinicians’ endorsement of purchasing PrEP online was important in convincing men of the legitimacy of the practice and men would have much preferred the NHS to actually provide PrEP, according to a study in PLOS ONE.”

Studies show a significant rise in bacterial STIs in men who are using PrEP that appears to be related to their sexual networks and the level of condom use. Even if PrEP is the game-changer many are hoping it to be, PrEP offers zero protection against other STIs which are on the rise at a time when antibiotics are failing.

PEP

PEP (post-exposure prophylaxis)

Post Exposure Prophylaxis (PEP) is a course of medication after a potential exposure, designed to reduce the risk of HIV infection. It is the same meds that are used to treat HIV.

The course of medication lasts 28 days and may be able to prevent you becoming infected with HIV if you start taking it within 72 hours of being at risk of HIV exposure; eg: a condom break during fucking.

If you think you may need PEP don’t spend the next 72 hours wondering, or searching the Internet for the right advice. The right advice is right here and you should go to a sexual health clinic now as time is of the essence. You can also obtain PEP at A&E (Accident and Emergency) departments of some hospitals. A&Es are especially important at weekends because most sexual health clinics are closed.

SXT

SXT search for sexual health services

SXT is a free on-line service (also available as an app) that helps find the right type of sexual health service at a convenient time near you including screening, HIV testing, chlamydia testing, PEP and sexual assault. Run by professionals, SXT has a database of more than 2,500 clinics across the UK and is open for everyone: all genders, ethnic groups and sexualities.

HIV AND THE LAW

HIV and the law

There is no law saying you must tell people you have HIV if you are having protected sex, and it’s your choice whether you tell sexual partners whether you have HIV or not. However, you may be prosecuted and found guilty of reckless HIV transmission if all of the following apply:

You knew you had HIV

You understood how HIV is transmitted and that you might be infectious

You had sex with someone who didn’t know you had HIV

You had sex without a condom

You are the only the person who could have transmitted HIV to that person.

Meaning of the word reckless

“Marked by lack of proper caution; careless of consequences.”” (Merriam-Webster)

If you say that someone is reckless, you mean that they act in a way which shows that they do not care about danger or the effect their behaviour will have on other people.” (Collins)

“A person whos actions are putting the people around him in harms way.” (Urban Dictionary)

“Heedless of danger or the consequences of one’s actions; rash or impetuous.” (Google)

As you can imagine, criminal law is complicated and there are variations for England and Wales, Northern Ireland, and Scotland.

Clearly defines “consent” as a person consents if she/he agrees by choice and has the freedom and capacity to make that choice. Sets out evidential and conclusive presumptions about consent.

Reclassifies rape as the penetration by the penis of somebody’s vagina, anus or mouth, without consent.

Creates a new offence of assault by penetration, the insertion of a body part or foreign object, such as a bottle, into the anus or vagina without consent.

Redefines sexual assault as an intentional sexual touching without consent. It can include touching any part of the body, clothed or unclothed, by either a body part or an object.

Sets the age of a “child” at 18, amending the Protection of Children Act 1978, and provides a defence for all sexual offences when the child is 16 or over and the relationship is consensual.

Classifies any sexual intercourse with a child aged 12 or younger as rape.

Establishes a raft of new criminal offences including crimes involving familial sexual abuse, offences involving adult relatives and offences designed to give protection to persons with a mental disorder.

Re-enacts the offences of abuse of a position of trust towards a child. This prohibits sexual contact between adults and children under 18 in schools, colleges and residential care.

Creates a number of offences related to “intent” including a new offence targeting drinks spiking.

Makes it an offence to give someone a substance without their consent and with the intention of stupefying or overpowering them so that any kind of sexual activity can take place. Two other “intent” offences cover situations where a person commits any offence with the intention of committing a sexual offence or where a person is a trespasser, he intends to commit a sexual offence on the premises and he knows that he is a trespasser,

Creates several new initiatives to protect children and the general public from sex offenders. The act allows dual criminality, meaning notification orders can be extended to those convicted abroad, and creates a civil order, the sexual offences prevention order, which combines sex offender orders (Crime and Disorder Act 1998) and restraining orders (Sex Offenders Act 1997).

Requires convicted sex offenders to register with their local police every year instead of every five years.

Introduces risk of sexual harm orders, specifically designed to protect children, and also creates foreign travel orders, which can be used to prevent an offender with a conviction for a sex offence against a child from travelling to countries where he is at risk of abusing children.

A new offence of voyeurism relating to those who observe others doing private acts without their knowledge for sexual gratification.

Decriminalises a series of sexual acts including the offences of gross indecency, buggery and soliciting by men (cruising).

SEXUAL HEALTH SERVICE CUTS

Sexual health service cuts

“Access to sexual health and HIV services has been dramatically reduced as a result of changes to the funding and organisation of sexual health services since 2013, according to the medical professionals providing care. Over half (54%) of respondents to a survey of members of the British Association of Sexual Health and HIV (BASHH) reported decreases in the overall level of service access to patients over the past year, with a further 16 per cent saying that access had significantly decreased. In a parallel survey of members of the British HIV Association (BHIVA), three quarters (76%) of respondents said that care delivered to patients in their HIV service had worsened.”

Kat Smithson, Director of Policy and Campaigns at NAT (National AIDS Trust) said: “The sexual health crisis is no longer a disaster waiting to happen, it is unfolding before our eyes. At a time when we have increasing rates in many STIs, we are destroying opportunities to diagnose and treat them. Clinicians are telling us that the very services that achieved success by reducing rates of HIV, are now under threat, putting this success at risk.

“In 2016 the Health Select Committee warned that public health budget cuts were a false economy, but was ignored. Now, as the same Committee conducts an inquiry on sexual health, we see the results: increasing sexual health inequalities, particularly affecting gay and bisexual men and BAME communities, and diminishing quality of services.

“As it stands, new funding for the NHS won’t benefit these health services that are actually delivered by local authorities through the public health grant. These continue to be cut right under our noses. Public health, which includes sexual health, drug and alcohol services, is in dire need of reinvestment.”

Something which may have passed you by in 2017 is the roll-out of the London Sexual Health Transformation Programme “…a partnership of 29 London boroughs with the aim of drawing together a new collaborative commissioning model for sexual health services” say London Councils. “From April 2017, when the Programme is due to be implemented, patients will be able to access services through the internet rather than having to attend a clinic.”

As the Programme is being rolled out, 6 sexual health services have closed, to date:

The Lloyd Clinic

Clare Simpson Sexual Health Clinic

Marlborough Clinic

The Courtyard Clinic

Artesian Health Centre Sexual Health Clinic

Vauxhall Riverside Sexual Health Clinic

MEN R US has asked about other clinics which we believe may be at risk, but we are (still) waiting for responses to our enquiries. However, we suspect more closures are on the way.

Online system not online until 2018

Worryingly, we understand that the web portal system where we (the patients) will access services is not online as planned. It appears we will have wait until 2018 at a time when there are already reports of sexual health services becoming further stretched, and turning away patients.

Poor communication

Communication regarding the closures seems to have been poor, the public often confused about what is open and closed. Ultimately, one gets the impression this Programme is more about the ‘transformation’ of sexual health services by stealth.

Dean Street Express massively over-subscribed

According to Gay Star News (27/10/17) “Around 1,500 people are trying to get just 300 appointments at the most popular sexual health clinic for gay and bi men in the UK, after other clinics closed.” Dean Street Express replied “our service is currently massively over-subscribed due to the closure of several other clinics in London.”

Industry award for the London Sexual Health Transformation Programme

There is some good news, however: Earlier this year the London Sexual Health Transformation Programme won an industry award from the Municipal Journal for ‘Reinventing Public Services.’ So no likelihood of an omnishambles then!

Cuts in England

The British Medical Journal (BMJ) sent freedom of information (FoI) requests about sexual health service provision and spending over the past three years to all 152 commissioning local authorities, 147 of which (97%) responded. Only 33 said that they had not reduced spending in any given year, whether by making efficiencies, through direct cuts to services, or because of natural variations in demand; 50 had done so in one year, 37 in two, and 27 in all three years.

Most of these annual reductions in spend were between 5% and 10%, but they ranged from 0.4% to 23%, the FoI responses show. And it’s likely that councils have now explored all viable options to contain costs.

The government public health grant, out of which sexual services are funded, has been steadily cut since 2015. It had an unscheduled 6% cut (£200m) in 2015-16. Scheduled annual cuts will amount to 9.6% by 2020-21.

Sign the petition

Sign the petition here created by the British Association for Sexual Health and HIV to The Secretary of State for Health to reverse the damaging cuts to the public health budget in England and provide sufficient funding to ensure that patients can continue to access high-quality sexual health services throughout the country.

Sexual health service survey

There have been worrying stories about sexual health clinic closures and difficulties getting appointments. This is a cause for concern since quick and easy access to testing and treatment is vital if we are to control STIs and HIV. The National AIDS Trust (NAT) and the Terrence Higgins Trust (THT) have put together a survey to establish the extent of the problem.

“This new analysis from the King’s Fund paints an extremely worrying picture for sexual health services across the country. With the dust having barely settled from the news that the first cases of gonorrhoea resistant to all known antibiotics have now been identified in three countries, the prospect of sexual health services facing further significant cuts to funding could not come at a more dangerous time.

With an unprecedented demand for services, coupled with record levels of new STI diagnoses and treatment-resistant infection, we are truly facing the prospect of a ‘perfect storm’ in sexual health. It is essential that the new Government ensures sexual health services are appropriately funded so that vital sexual health promotion, prevention, testing and treatment can be delivered. Failing to do so is the falsest of false economies and the consequences will be felt for years to come.”

Dr Elizabeth Carlin, BASHH President, commenting on the King’s Fund findings showing that local councils are planning on making large cuts to funding for sexual health services | Jul 2017

NATIONAL AIDS TRUST

National AIDS Trust

The National AIDS Trust (NAT) was founded in 1987 as a non-government organisation (NGO) by the Department of Health, in order to deal with the escalating concern with HIV and AIDS nationally. Today NAT’s funding comes from public donations, corporate supporters, grant-making trusts and foundations and its own fundraising work – it doesn’t receive funding from the UK Government. NAT is a policy and campaigning charity, working to improve the national response to HIV through policy development, expertise, and the provision of practical resources rather than through offering direct support services to people living with HIV.

Alarming trend for cutting or completely decommissioning HIV support services

Freedom of Information requests have exposed an alarming trend for cutting or completely decommissioning HIV support services across England and Wales. In England there was an average cut of 28% in expenditure for HIV support services between 2015/16 and 2016/17. The regional variation in cuts is enormous, with some areas entirely losing support for people living with HIV.

NAT also has a comprehensive range of resources available including: HIV in the future NHS, why PrEP is needed, your rights: a guide to human rights and HIV, your voice: a guide to disclosure and HIV, using the global evidence base to reduce the impact of HIV stigma, how NHS overseas visitors charges apply to migrants and asylum seekers in England, preparing for Personal Independence Payment (PIP), and tackling HIV discrimination at work.

The Food Chain

The Food Chain

The Food Chain delivers meals and groceries, offer cookery and nutrition classes and communal eating opportunities to people living with HIV in London and their dependants. Inspired by their practical response, hundreds of volunteers deliver its services, supported by a staff team.

People living with HIV often struggle to access the food they need to stay well, because of ill health, poverty, isolation and a lack of motivation to eat well, or limited skills or knowledge.

Every service user is referred by a health or social care professional who has identified them in need of nutritional support. Each service user receives a personalised nutrition care plan designed specifically to meet their needs. By offering a tailored package of support, at the appropriate time, The Food Chain helps people to lead healthy, independent lives.

Check ups

Sexual health clinics

Sexual health clinics or services provide treatment for Sexually Transmitted Infections (STIs) and practical help to reduce the risk of getting them in the future. Some services are referred to as Genito Urinary Medicine (GUM) clinics which is the medical term for this field of medicine.

For many years, ‘GUM’ or ‘clap’ clinics were hidden away in hospital basements but many improved from the 1990s, with changes driven largely by gay men, developing a more positive and comprehensive understanding of gay men’s health. And for those who want them, there are clinics specifically for gay men, and evening opening times.

Having said that, improvements are not universal and the quality of service can vary between clinics. In some cases, thankfully more rarely today, we can still be patronised and mistreated by homophobic and judgemental staff, although they do seem to be on the way out.

If you are sexually active, finding a GUM clinic you like is essential, particularly if you can build up a good relationship, if required.

With few exceptions, most of us use clinics run by the National Health Service – they’re free (including treatment prescriptions) and generally very good. Alternatively, you can go to a private clinic and pay for it. Depending on where you live and work, it can be worth thinking about the clinic location, although this should be a secondary consideration after the quality of the service you receive. Even if there’s just the one locally, some gay men do go elsewhere to reduce the likelihood of recognition or because the service is crap. So shop around to find a clinic which best suits your needs.

Go online or phone up the clinic and find out if you need an appointment, or whether it is a ‘walk-in’ service. ‘Walk-in’ clinics can be very busy and it’s almost impossible to gauge how long you’ll be there. It is advisable to put aside a morning or afternoon until you have a clearer idea of how the clinic works. You might want to ask if they have a special clinic for gay men if that’s what you’re after.

Confidentiality

Sexual health clinics (STI clinics) are bound by law to ensure the confidentiality of your records, so it’s OK to give your real name and address. All information about you and your sexual health is protected by law under the NHS Trusts and Primary Care Trusts (Sexually Transmitted Diseases) Directions 2000 and The NHS (Venereal Diseases) Regulations 1974.

In September 2015 a breach occurred where the 56 Dean Street clinic sent out the names and email addresses of 780 people when a newsletter was issued to clinic patients. Although this was appalling it was an exceptionally very rare occurrence in the sexual health field. Patients were supposed to be blind-copied into the email but instead details were sent as a group email.

If you’re going to have an HIV antibody test you may decide to give a false name, and this is not against the law. However, don’t forget it… and any other false information you provide. Unfortunately, the same standard of confidentiality cannot be assured outside your clinic if you’re referred to another hospital department or service.

When you arrive

When you arrive you should report to reception, where you will be booked in and given a numbered ticket (depending on the system). You then wait until your ticket number or name is called. If it’s your first time, you may need to answer a few questions or complete a short questionnaire.

Some guys feel the need to give a different name which is OK as long as you remember it… and respond when it’s called out! At some point you will be given a reference number. Don’t lose it as it links you with your clinic file which sits amongst tens of thousands of other records. Although they can be found by your name and/ or date of birth, looking for records in this way causes delays and extra waiting time for you.

Visits may take up to 2 hours, sometimes longer, so don’t be afraid to ask how long it is expected to take. Longer waits usually occur in clinics that provide a ‘walk-in’ service where it can be difficult to match demand with staff. If the waiting room is packed and the clinic is short staffed, you could be there for several hours – it’s unavoidable. Pre-arranged appointments are more likely to keep to time, but are prone to delays like any health service.

Everyone is there for the same reasons and nobody is likely to feel any less awkward than you. Just get on with it; take a book or watch a movie on your phone to pass away the time. Some clinics even have free wifi.

The consultation

Practice varies between clinics but you can usually expect the following during a clinic visit:

Routine check ups

If you are going for a regular check-up with no concerns or symptoms (that you know of) you will be asked for some or all of the following:

Complete a short questionnaire

Pee in a pot

Swabs from bum and/ or throat depending on the sex you’ve had (for gonorrhoea, chlamydia)

Bloods tests for syphilis, HIV and viral Hepatitis

Check ups with concerns or symptom

You will be seen by a clinician (a nurse or doctor) who will find out about your reason for attending the clinic

You will be called by name or number and shown to a consulting room and while the consultation is taking place the door should be closed

Clinicians should introduce themselves (sometimes there is a student present and you should be asked whether this is OK. If you’d rather see the clinician alone – say so, particularly if it’s your first time at the clinic or if you are feeling in any way nervous)

You will be asked about any problems or concerns you might have. Explain in your own words what seems to be the matter and describe any symptoms

You may also be asked these sorts of questions…

How many people you’ve had sex with recently and their sex

Whether your partners were casual, known to you or regular

The kind of sex you’ve had and whether you used condoms (or not)

Whether you’ve had STIs before

If you have been vaccinated for hepatitis in the past (as you may need a booster)

Your alcohol intake and recreational drug use

General health problems, are taking medication or have allergies

Difficult and embarrassing though they might be, be truthful, and be as specific as possible. If you hide anything (eg: say you always use condoms when in fact you don’t) or are economical with truth, you may be not be tested for something you have.

The examination

Depending on why you are attending you will be examined, this is likely to include:

the cock and balls

the throat and the glands in your throat

arsehole

the skin.

You will need to provide samples to find out whether you have a sexually transmitted infection.

Swabs

Using swabs, samples are taken from:

your pee hole

your throat

your arsehole

you may also be asked for a urine sample

These are used to test for gonorrhoea, chlamydia, pus in the rectum, or penis (proctitis or NSU).

Blood tests

You will then be asked to give a blood sample for syphilis, HIV and Hepatitis

Initial test results

Some of the test results will be available during your visit so after you have been examined and provided the necessary samples, you are likely to be returned to the waiting area for a short time before seeing the nurse or doctor again.

Treatment

Depending on the diagnosis you may be given a course of treatment (usually antibiotics)

Other test results

The rest of your results will take a week or so and you will have to go back to get them and most clinics communicate your results by text or telephone, however you may be asked to attend for your results or review.

At the end

Thoughtful clinicians will close your session by checking that everything is OK and give you an opportunity to ask any other questions.

Surveys, studies and trials

Sometimes there may be a member of staff ‘hovering’ in the waiting area with a survey. Feel free to say no, but it’s a way to pass the time and support the clinic in its work.

If you are receiving HIV treatments/ therapies, you may be asked to take part in a clinical trial or survey (especially if you are newly diagnosed).

Before you make any decision you need to understand the purpose of the survey/ trial etc; what is involved; your rights; and whether there are any dangers or risks. If you have difficulty in understanding what is being asked of you, ask that the questions or information are rephrased or re-explained. You should also be given time to think about what has been said before you make any decision.

Treatment

If you have a STI then you’ll be prescribed a course of treatment. If you’re given antibiotics then it is very important that you complete the whole course even if you think the symptoms have gone away.

The infection may not have been fully cured and if it comes back then it can be more difficult to treat second time round. You will be asked to come back to check the infection has gone away.

If you don’t understand what the treatment is and you want to know, don’t be afraid to ask. If you are unhappy with what you’ve been given then ask if there’s an alternative. All treatment and prescriptions are free.

Telling partners

If you have or have had a recent infection you should tell all your partners (if you can) so that they can also go for check-ups. This may not be easy – but think about it if the roles were reversed.

Clinics will want to make sure that all your recent partners are traced so that they can be warned that they need a check-up too. Just assure the clinic that you will personally tell all your partners. Then do it!

Alternatively, there is ‘provider referral’ where a clinic will contact partners on your behalf anonymously. All you have to do is give the clinic his first name and mobile number. They will do the rest and will not identify you at all.

Remember, you can have most STIs without there being any external or recognisable symptoms. The situation is more complex if you test HIV antibody positive but the health adviser should help you tackle the issues.

The service you can expect

Generally clinics provide an excellent and consistent service and, you should be to

Understand and be kept fully informed about what’s going on

Have questions asked with sensitivity and in plain language

Have time and attention to express concerns and ask questions

Have your questions answered honestly and in plain language

Be given time to understand the answers

Be asked for your consent to any tests or treatments

Communication works both ways

Occasionally staff assume you are straight (heterosexual) and/ or may only have a limited understanding of gay sex. If you feel the line of questioning is insensitive or offensive so say: firmly but politely. Clarifying something can be awkward and embarrassing but trends in gay sex can be complicated and fast moving (the language and apps we use, for example). Providing your knowledge can also help staff and clinics in the work they do.

Saying thank you and making complaints

Acknowledging when and where clinics get it right is just as important as complaining. Dedicated staff work very hard to ensure that clinic services meet our needs with the least discomfort and embarrassment. Quite simply, if you’re pleased with the service say-so and spread the word.

Making a complaint can be difficult and embarrassing, particularly if it involves coming face to face (again) with the member of staff about whom you’re complaining. Think carefully about

why you are complaining

what you want to say

what you want to get out of the situation.

Maybe it’s an apology you want, or an improvement in the service you’ve received?

Being clear and calm will not just help you but also the clinic in understanding why you’ve made the complaint in the first place. You may want to deal with the situation then and there. Alternatively, when you get home make a note of the incident before contacting the clinic again. An irate call to the clinic may make you feel better but unless you provide your name, who was involved, and what happened, it’s unlikely that the clinic can carry the complaint further).

It may be useful to talk it through with a friend – preferably one who’ll be supportive but objective. If you don’t wish to contact the member of staff concerned directly, try the clinic’s business manager or senior clinician. Some clinics have a system for complaints and suggestions and this may be a useful place to start.

Patient Advice and Liaison Service (PALS)

Alternatively, clinics are usually part of a hospital or NHS type Trust with a Patient Advice and Liaison Service where you can raise your concern or make your complaint through them.

HIV stigma

HIV stigma

Over the decades of the HIV/ AIDS epidemic there have been many advances in treatment and care, and HIV is now considered to be a chronic medical condition rather than the fatal illness it once was. Unfortunately, people living with HIV have been stigmatised and discriminated against since the virus was first discovered in the 1980s, and it continues…

Today, stigma and discrimination faced by people living with HIV remains a major issue. It appears in many forms and ranges from rejection by friends, family or partners to being physically assaulted. It’s also a distinctly unattractive trait among some gay men using hook-up web apps.

stigma ˈstɪɡmə/ nounMark of shame and humiliation often driven by views, beliefs and assumptions we make about people. Makes it more likely that people will be singled out, ostracised, or marked out as strange, different (not in a nice way) and, in some cases, thought of as dangerous. Stigma is crippling, bringing on feelings of isolation, shame, hopelessness, blame, self-hatred, which often prevents people from seeking help and support.

As well as leading to feelings of isolation, depression and fear, stigma can also contribute to the spread of HIV. If someone is scared to go for a test, they may not know that they are HIV positive, and that could lead to them unknowingly infecting someone else. Fear of testing is often what leads to people being diagnosed late, which means they are in poorer health when diagnosed and in turn may not respond as quickly or as well to treatment, which ultimately means they reduced their opportunities for returning to good health.

World AIDS Day

Since 1988, 1 December every year is dedicated to World AIDS Day, raising awareness of the AIDS pandemic caused by the spread of HIV infection, to show solidarity with people living with HIV, and mourning those who have died.

For many, 1 December is associated with the red ribbon which has become an instantly recognisable symbol.

The red ribbon

The red ribbon is a symbol of solidarity and of the commitment to the fight against HIV and AIDS. The Ribbon Project was conceived in 1991 by Visual AIDS, a New York-based charity group of art professionals that aims to recognize and honour friends and colleagues who have died or are dying of AIDS. The ribbon made its public debut at the 1991 Tony Awards, but since then – in some circles – has become a popular and politically correct fashion statement for celebrities at other awards ceremonies. Because of this popularity, some activists have rightly worried that the ribbon is simply paying lip service to AIDS causes. Nevertheless, it is a powerful symbol for all of us around the world, and a unifying symbol on World AIDS Day (1 December). Today, the red ribbon is an international symbol and, for many, stands for care, concern, hope and support.

The UK AIDS Memorial Quilt tells the stories of many of those lost in the early days of the HIV AIDS epidemic in the 80’s and 90’s. Representing approximately 384 people from all around the UK, there are 48 twelve foot by twelve foot panels, each comprising up to 8 smaller panels. Each panel is approximately 4m sq. Each individual panel commemorates someone who died of AIDS and has been lovingly made by their friends, lovers or family. Lives remembered include those of the writer, Bruce Chatwin; the artist/film maker Derek Jarman; the actors, Ian Charleson and Denham Elliot; gay rights activist, Mark Ashton and the photographer Robert Mapplethorpe.

Several charities have created the AIDS Memorial Quilt Conservation Partnership, to raise awareness of the quilt, its importance in our history and to restore and conserve the quilt for generations to come: George House Trust, Terrence Higgins Trust, The Food Chain, Sahir House, Positively UK and Positively East.

Weighing an estimated 54 (US) tons (48,988 kilograms), the (NAMES Project) AIDS Memorial Quilt is an enormous quilt made as a memorial to celebrate the lives of people who have died of HIV and AIDS, and related illnesses. As of June 2016, the Quilt is composed of more than 49,000 panels on 5,956 blocks (blocks are the twelve foot square building blocks of The Quilt seen at displays). Most blocks are composed of 8 separate panels, remembering the lives of eight individuals lost to AIDS.

Books

“Upon it’s first publication twenty years ago, “And the band played on” was quickly recognised as a masterpiece of investigative reporting. An international bestseller, a nominee for the National Book Critics Circle Award, and made into a critically acclaimed film, Shilts’ expose revealed why AIDS was allowed to spread unchecked during the early 80’s while the most trusted institutions ignored or denied the threat. One of the few true modern classics, it changed and framed how AIDS was discussed in the following years. “And the band played on” remains one of the essential books of our time.” [Macmillan]

“And the band played on” is also a 1993 American television film docudrama based on the the book. The film premiered at the Montreal World Film Festival before being broadcast by HBO on September 11, 1993.

“The End Of Innocence” looks at a decade of AIDS in Britain. As well as the 8000 who have died, some 20,000 are infected with HIV, and many more carry the virus unknowingly. With no cure or even a vaccine in sight, and growing evidence of complacency, AIDS is still one of the greatest post-war challenges the UK faces.

This book covers every significant development of the disease, from the early ignorance and panic to the emergence of AIDS as a good cause taken up by Sir Ian McKellen, George Michael and the Princess of Wales. The author uses information supplied by doctors, scientists, government ministers and civil servants, as well as interviews with leading entertainment figures such as Stephen Fry, Elton John and the late Derek Jarman.”

In 1995, the BBC made a documentary based on the book highlighting the shameful attitudes of the British public and politicians during the 80s and early 90s towards HIV/AIDS awareness, education and gay men.

“AIDS: Don’t Die of Prejudice” is both an in-depth investigation and an impassioned call to arms against the greatest public health threat in the world today. Norman Fowler has travelled to nine cities around the globe to report on the position today. What he discovered was a shocking blend of ignorance, prejudice, bigotry and intolerance. In Africa and Eastern Europe, a rising tide of discrimination against gays and lesbians prevents many from coming forward for testing. In Russia, drug users are dying because an intolerant government refuses to introduce the policies that would save them. Extraordinarily, Washington has followed suit and excluded financial help for proven policies on drugs, and has turned its back on sex workers.

In this lucid yet powerful account, Norman Fowler reveals the steps that must be taken to prevent a global tragedy. ” [Biteback Publishing]

“How to Survive a Plague by David France is the riveting, powerful and profoundly moving story of the AIDS epidemic and the grass-roots movement of activists, many of them facing their own life-or-death struggles, who grabbed the reins of scientific research to help develop the drugs that turned HIV from a mostly fatal infection to a manageable disease.

Around the globe, the 15.8 million people taking anti-AIDS drugs today are alive thanks to their efforts. Not since the publication of Randy Shilts’s now classic And the Band Played On in 1987 has a book sought to measure the AIDS plague in such brutally human, intimate, and soaring terms. Weaving together the stories of dozens of individuals, this is an insider’s account of a pivotal moment in our history and one that changed the way that medical science is practised worldwide.” [Pan Macmillans]

In 1993, Gideon Mendel spent a number of weeks photographing the Broderip and Charles Bell wards in London’s Middlesex Hospital as part of the ‘Positive Lives’ project. The Broderip was the first AIDS ward in London and was opened by Diana, Princess of Wales in 1987, this year marking the 30th anniversary of its opening. This was the era before antiretroviral medications had become available, a very distinct and tragic time. All of the patients on the wards, many of whom were young, gay men, were having to face the terrifying prospect of an early and painful death.

These two wards at The Middlesex Hospital were some of the few dedicated AIDS wards that existed in London, and even more unusual for their decision to open themselves to being photographed. Considering the high levels of stigma and fear that existed at the time, the decision of these four patients to allow themselves, alongside their families, lovers and friends to be photographed was an act of considerable bravery. ‘The Ward’ explores through Gideon Mendel’s evocative black and white photographs how it felt to live with HIV at this time when it was considered a veritable death sentence. It shows how the ward at the Middlesex Hospital became more like a second home, and the staff and patients friends.

"Killer in the village" BBC Horizon (1983)

A rise in the demand for Pentamidine to treat pneumocystis pneumonia alerted health authorities to HIV/AIDS. First transmitted in 1983, Horizon traces the spread of AIDS across America. AIDS – Acquired Immune Deficiency Syndrome – was only named in 1982, and was still largely unknown. This programme follows the search for a cause and cure, and asks whether the seeds of a spreading epidemic had already reached London.

HIV story project

HIV Story Project

Founded in 2009, The HIV Story Project is a San Francisco based non-profit organisation focused on bridging HIV/AIDS with film, media and storytelling to fight the pandemic and the global stigma associated with it.

Generations HIV is a digital media experiment recording video questions, answers and stories by people from all walks of life about HIV/AIDS. Whether HIV+ or HIV-, a loved one or a caregiver, we have all been impacted and affected by this global health pandemic, and we all have a story to tell.

Condoms

From tortoise shell to latex

The most effective way to protect yourself and your partner(s) from the risk of infection from STIs is the use of condoms and water-based lubricant – every time when you get fucked or fuck.

In the past, condoms have been made out of all sorts of materials: horn or tortoise shell for that extra sensitive gentle touch, oiled paper, linen or animal gut. Up until the 1930s rubber condoms were thick, washable and re-usable.

However, the development of latex in the late 1930s meant that thinner, disposable condoms could be produced. More recently we have seen the arrival of a polyurethane condom which is said to be stronger than latex, although more expensive. However, being thinner, sensitivity should be greater and it is the only condom which can be used with oil-based lubricants.

A little tedious perhaps but we feel we should clarify that MEN R US has no relationship with any of the condom manufacturers featured in this section, and acknowledges there are many many other brands available to purchase online, from chemists, shops and supermarkets, etc… but some are also FREE from many sexual health clinics.

Stronger condoms

For many years, stronger condoms have been the bedrock of HIV prevention, though the landscape is changing. Today, there’s a shift to choosing the right condom (which may not necessarily need be thicker) with good technique and plenty of lubricant.

In 2001, an evaluation concluded “…there is no evidence from the present investigation to support the use of stronger (thicker) condoms over standard strength condoms among gay men. The appropriate use of additional lubricant should be encouraged.”

Obviously thicker condoms will lessen dick sensitivity and, although they offer better protection under ideal circumstances, the benefits may be outweighed if your dick is so de-sensitised that you have to ferret around for hours before you can cum. On the other hand, guys often love a good ferret! It’s your choice: if you feel safer and more secure using a stronger and/ or thicker condom then use them!

Nonoxnol-9

Nonoxynol-9 is widely used in contraceptives for its spermicidal properties (it kills sperm on contact). It has been promoted as a backup method for avoiding pregnancy and to protect against STIs in the event of condom failure.

In the late 1990s, studies have found that condoms with nonoxynol-9 can irritate the lining of the rectum/ arse leading to increased risk of STI transmission, including HIV. Most condom manufacturers in the UK have stopped using N-9, but avoid condoms described as spermicidally lubricated.

Condom standards

You may find several standards stamped on condom wrappers but, in our opinion, our order of preference is:

ISO Standard is managed by the International Organization for Standardisation; give world-class specifications for products, services and systems, to ensure quality, safety and efficiency; and are instrumental in facilitating international trade.

CE Mark is a European Economic Area symbol of licence approval. It therefore means that it meets all the requirements of European Legislation.

BSI Kitemark is the registered trademark owned by the British Standard Institution, an accepted sign of reliability and a significant assurance that a product meets rigorous standards of production and testing.

Latex and non-latex

Latex condoms weaken and damage easily when they come into contact with oil-based lubricants and other substances such as baby oil, mineral oil, suntan lotion, cooking oil, baby oil, petroleum jelly, cold creams, skin lotions and, bringing up the rear so to speak, butter or margarine.

Synthetic latex

A type of plastic (eg: polyisprene and polyurethane) which doesn’t irritate people with latex allergies. Though less stretchy than natural rubber latex, synthetic latex condoms can be very thin and be used with oil based lubricants.

Lambskin condoms

An alternative to latex and non-latex condoms made from a thin layer of sheep cecum, a part of the intestine. We mention them because you may come across them but they DO NOT prevent the transmission of viral STIs including HIV and herpes. On the upside the lambskin condoms are effective against pregnancy, they don’t trigger latex allergies, are biodegradable and can be used with oil-based lubricants.

New to the market, Glyde condoms come in several sizes, are made of natural rubber latex (with only natural and vegan colours and flavours) and are suitable for use with water based or silicone based lubricants.

Condom considerations and jargon

Condom Measurements

Whether clubbing, dining, or attending an interview, most of us think about what we’re going to wear. The cut of the clothes, the colour combo, and the impact bring it all together. But when it comes to sex, we can be so fixated on the fuck we forget that the right condom can give you and your partner(s) more pleasure, more security, and more fun.

You shouldn’t really feel a perfectly fitting condom. Too large and it can slip off (and yes: up the arse). If it’s too small it can be a bugger to put on (as your dick is choked to death) and it’s more likely to break while fucking. So while condom length is important its girth (or width) should also be a consideration. More of this later.

When choosing a condom, principle considerations should be:

its thickness (usually given in microns)

its width (and width at the head of the condom if it’s not a straight condom).

its length

Condom choice

The choice of condoms is bewildering and you can start to wonder why you might need an extra thin, non- lubricated, banana-flavoured, slim-fit condom. What is doubly frustrating is that comparing brands is just about impossible. Here are the options:

Standard condoms have straight sides

Fitted or trim condoms are slightly narrower below the dick head

Thinner or sensitive condoms are so you feel more; conversely, some guys will avoid them because they cum too quickly

Large, XL, or magnum condoms are longer and wider, including over the head of the dick

Extra strong or stronger condoms are usually thicker, but not always. According to manufacturers, some thin condoms claim to be as strong as stronger condoms

Textured condoms with ribs and bumps can increase sensation, but not everyone likes speed bumps

Coloured condoms can make oral sex more fun. Also, they could be a perfect choice for St Valentine’s or St Patrick’s Day, with matching flavours such as strawberry or mint. If you are planning to use a liquorice flavoured condom to accompany that black tie event we would advise you to warn your partner(s) in advance!

Flavoured condoms are just that, and some of the flavours can be an acquired taste. Who can forget minty mouthful, blow me bubblegum, bangin’ banana, chocolate temptation, blueberry muffin, fizzy cola, blowdom cannabis and succulent strawberry. They are great for oral sex, particularly for guys who are not into fucking

Non lubricated condoms are a sensible choice if you don’t like the taste of lubricated condoms. Great for sucking or you can add the lube of your choice if you’re fucking. Trivia: they are also used as protective covers for microphones and ultra sound machines, and for keeping stuff dry on camping trips.

Glow in the dark condoms have rather stumped us, but supposedly handy in a dark room? If anyone has an interesting tale to tell we’d love to hear from you.

Desensitising, extended play and delay condoms are for guys want to last longer before cumming or for guys who cum too quickly. They use a lubricant that slightly desensitises your dick which makes it a little numb. No harm, of course, but you have been warned.

We have trawled the websites of many well known manufacturers and distributors. While some provide condom length, width and thickness; others seem to be more interested in a sales pitch (for their own brands) and/ or posting customer reviews which are subjective, and not necessarily that helpful.

Measuring dick

Finding the best condom fit takes some measuring on your part. You will need:

Stimulation to make you hard and erect; eg: a vivid imagination, porn, a man

A place where you will not be disturbed

A flexible sewing tape or tailors measure OR a ruler and a piece of string

A pen and paper

A man (optional)

A sense of humour (optional)

Place the tape or ruler along the length of your erect throbbing dick from the base to the tip. Bear in mind rulers often have a few ml at the end which you need to take into account (i.e. discount). Write down the measurement.

Measure the girth or circumference of your penis with the tape around the thickest part of your dick (or loop the string around then use the ruler to calculate). Write down the measurement.

Even if Fred applies his measurements to website condom calculators, more often than not results show only those brands that the site sells. And he’s wary about buying a brand he’s not heard of before, or he might already prefer a brand which they don’t sell.

Many websites also have charts which show at a glance that if your dick is ‘X’ wide and ‘Y’ long your condom size is ‘Z’. The trouble is, when we compared 6 sites, we found 5 different condom width sizes for a dick with a 155mm girth with a range in difference of 8mm (that’s nearly a centimetre). That’s enough for a condom to easily slip off a smaller dick or choke a larger one!

Condom companies

Even when you work out your condom size, the information provided by many the major condom manufacturers is variable or does not exist.

Using condoms

We just couldn’t give it to you straight, so here is our take on using condoms.

If you’re going to fuck make sure you have condoms and lube to hand and remove all pets and ex-boyfriends from the area!

Checking the use-by date first, take the rubber out of its wrapper avoiding sharp/jagged finger nails, teeth and cheap jewellery.

With a thumb and forefinger pinch the end of the condom as this will get rid of the air and make room for the cum.

Make sure it’s not upside down or you won’t be going anywhere!

Roll it all the way down your dick. A hard dick makes this easier to do but it may go soft at this point. Simply work up some steam and – using a new condom, try again later.

Place some lube on a finger or two and gently work it up his arsehole. He’ll get more pleasure if he’s relaxed and the condom is less likely to tear.

Smother your dick with lube and ask him if he’s ready before putting it up his arse.

Enter slowly, checking he’s OK. If you go in quickly you could hurt him. Once inside, off you go… checking occasionally to see that the condom is still in place and intact.

When you’ve finished, hold the condom at the base of your dick before pulling out. You don’t want to lose it up his arse do you?

Condoms do make a difference: You can’t feel as much and they can be awkward to use, BUT using them with lube every time you get fucked or fuck greatly reduces the risk of HIV infection and other STIs.

Condoms help protect against other sexually transmitted infections including gonorrhoea, syphilis, herpes, hepatitis, and NSU.

Wanking with condoms can also improve your technique and get you used to the idea/feel of using them.

Don’t leave condoms lying around for children to find as there is a risk of suffocation! Knot it, wrap it in a tissue or loo roll and bin it. (Not down the toilet, it may well bob back up).

Take a break… put on the kettle… leave… start again… or fall asleep in his arms.

Not checking the condom packet for damage: Condoms can easily get damaged, especially if they’ve been kept in a wallet, pocket, or bag. Condoms that are damaged won’t protect you from STIs and pregnancy

Not checking the expiry date: Condoms that are out of date won’t protect you from STIs

Putting the condom on after sex has started: You need to wear a condom before you start having sex in order for it to do its job. If you leave it to the last minute and only put a condom on just before you come (ejaculate) you’re NOT protected from STIs. If you do this, fluids are likely to have already been exchanged

Not holding the tip when applying the condom: When you put a condom on, it’s important to squeeze the tip, to get rid of any air. If you don’t, the condom is likely to break

Putting the condom on the wrong way up, then turning it over: Putting the condom on the wrong way round (so it won’t roll down) is a common mistake, especially if it’s dark! But if you do this, it’s really important that you bin that condom and start again with a new one. Don’t be tempted to just turn it over because the outside of the condom will have touched the penis and so leaves your partner exposed to the risk of pregnancy and/or STIs. Get another condom out and start again

Taking the condom off before sex is over: Whenever your genital or anal areas are in contact, you should use a condom, to prevent the risk of STI. This includes after you’ve come (ejaculated)

Using a condom that’s been in a wallet or bag for more than one month: Condoms can get warm when in a wallet or bag and this damages them. If they’ve been in there for more than one month, they are not safe to use. Carrying them with you is a great habit though, so just make sure you replace it at least once a month!

Not holding the base of the condom when withdrawing the penis: This can cause the condom to come off, which means you’re at risk of pregnancy and/or STIs

Using oil-based lubricants with condoms (such as Vaseline or moisturiser): Using lubricant is a great idea, but make sure it’s water-based (such as K.Y. Jelly or Durex Play). Other products, not intended for sex, are often oil-based and can eat into condoms, causing them to break.

“A rapid rise in the takeup of pills to prevent HIV infection in some parts of Australia has been accompanied by a steep drop in the numbers of men using condoms during sex with other men whether or not they are on the protective drugs, a major study has shown.

Pre-exposure prophylaxis, or PrEP, has been hailed as a game-changer in the Aids epidemic, but the Australian experience suggests the availability of once-a-day pills that reliably prevent transmission of the virus may play a part in complacency about the chances of becoming infected.

But experts say PrEP is not solely responsible. Condom use among gay and bisexual men has been declining for some time. One of the reasons will be the knowledge, thanks to research, that men who are on a cocktail of HIV drugs do not pass the virus on during sex.

However, the new study, published in the Lancet HIV journal, raises serious questions about the introduction of PrEP in developing countries with high levels of infection without a strong package of educational support to encourage condom use.”

Lubricants

Wonder of slippiness

While we’re probably preaching to the converted, arseholes and rectums are not self-lubricating. Though we may feel ‘wet’ at times, this small amount of natural mucus and sweat present (when fucking) can lead to discomfort, irritation, and infection without lube. We use 3 different types for sex:

water based lube

silicone based lube

oil based lube

Behaving similarly, they reduce the friction between whatever is going up your arse and the arse lining. However, you need the right amount of lube to do the job. Too much and the practicalities of what you’re trying to do become comedic/ faintly ridiculous. Too little and there is discomfort and pain (to both partners) and a risk of damaging the condom, the arse, or both.

Water-based lubes (for use with condoms)

Water-based lubes are considered the safest all-purpose lubricant choice. They do not damage or weaken latex condoms and, generally, do not irritate the inside of the arse. Particularly since the introduction of glycerine, they have come a long way since KY-jelly.

Water-based lubricants dry up eventually because your rectum absorbs the lubricant’s water content back into the body, leaving a sticky residue. Insufficient lubricant (of any kind) increases friction and is a major factor in condoms tearing or damage to the lining of your arse.

As a general rule a cheap-and-cheerful lube will work though dicks and arseholes may need re-lubing. More expensive lubes (often with glycerine) and sporting the latest in lube science will have more slippiness, lubiness, silkiness and smoothness.

Silicone based lubes (condom compatible)

Many of us find the texture of silicone-based lubes more pleasurable than other lubes and they certainly last much longer than water based lubes.

Silicone based lubricants don’t dry up because your arsehole and rectum is not capable of absorbing any of its components back into your body. It therefore stays there, goes further and lasts longer, but this in itself can cause ‘problems’: your lower intestine down to your arsehole can become a bob sleigh run and shit can shoot out at a moment’s notice!

It can also stain and thus be difficult to wash out of bedding and clothing, and it can cause damage to sex toys made of silicone.

Silicone based lubes like Wet Platinum, Eros, ID Millennium (there are others) are safe to use with all condoms, latex and polyurethane.

Oil based lubes (not condom compatible)

Oil-based lubricants don’t dry up because your arsehole and rectum is not capable of absorbing any of their components back into your body. It therefore stays there, goes further and lasts longer but this in itself can cause problems: your lower intestine down to your arsehole can become a bob-sleigh run and shit can shoot out at a moment’s notice!

If you’re into dildos or fisting then oil-based lubes are generally a better option because they last longer. If you have a fist up a mate’s arse, a comment like “excuse me, I’ve just got to pop out for some more lube”, doesn’t tend to go down well.

Oil-based lubricants and related oil-based substances weaken and damage condoms and should not be used together. These include baby oil, mineral oil, suntan lotions, cooking oil, petroleum jelly, butter or margarine, cold creams and skin lotions.

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